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Case Reports
. 2023 May 6;15(5):e38635.
doi: 10.7759/cureus.38635. eCollection 2023 May.

Hidden Behind a Veil: A Rare Case of Pulmonary Nocardiosis

Elizabeth George  1 , Chandramouli M T  1 , Nandakishore Baikunje  1 , Nandu Nair  1
Affiliations
Case Reports

Hidden Behind a Veil: A Rare Case of Pulmonary Nocardiosis

Elizabeth George et al. Cureus. .

Abstract

A 48-year-old male, a known case of seizure disorder, presented with complaints of cough for four months, which increased for two weeks, fever for two weeks and weight loss. Computed tomography (CT) scan of the thorax showed multiple heterogeneously enhancing lesions of bilateral lung fields predominantly in peribronchovascular distribution with enlarged, necrosed and conglomerated lymph nodes suggestive of infective etiology. On routine blood investigations, he was found to be reactive for the human immunodeficiency virus. He underwent bronchoscopy and bronchoalveolar lavage culture grew Nocardia. He was prescribed antibiotics based on susceptibility reports and the patient became symptomatically better after one month and was discharged.

Keywords: hiv aids; infectious diseases; nocardiosis; pulmonary medicine; tuberculosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Initial chest X-ray showing bilateral bronchopneumonia (solid arrows with green outline).
Figure 2
Figure 2. CT image showing ‘multiple heterogeneously enhancing lesions of bilateral lung fields’ in the lung window (arrows with black outline).
Figure 3
Figure 3. CT image showing ‘multiple heterogeneously enhancing lesions of bilateral lung fields’ in the lung window at a different area of the lung (solid arrows with green outline).
Figure 4
Figure 4. BAL gram staining in 100x magnification (oil immersion) showing gram-positive, filamentous bacilli.
Figure 5
Figure 5. BAL-modified AFB staining in 100x magnification (oil immersion) showing filamentous, branching AFB resembling Nocardia.
AFB: Acid-fast bacilli; BAL: Bronchoalveolar lavage
Figure 6
Figure 6. Chest X-ray taken at the time of discharge which shows the resolution of shadows when compared to the initial radiograph (solid arrows with green outline).
See this image and copyright information in PMC

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